Saturday, January 7, 2017

Pseudodementia is Often Curable

Pseudodementia walks and talks like dementia, but it often responds
positively, with treatment permanently improving cognition. Learn how
recognizing the difference can change one's life.

Pseudodementia was first coined in 1961 by psychiatrist Leslie Kiloh.
Dr. Kiloh noticed patients with cognitive symptoms consistent with
dementia who improved with treatment, a pattern inconsistent with the
progressive neurodegenerative nature of dementia.

Diagnosis

Pseudodementia can be caused by a large variety of underlying disorders,
but most commonly, it is depression masquerading as dementia.

Depressed elderly patients may exhibit substantial cognitive deficits.
To further complicate the clinician's task, people with dementia are
often depressed. For example, 20% to 40% of Alzheimer's patients have
major depression (Brown, 2005). This makes the relationship between
depression and dementia very complicated. So the question is how to
differentiate the two.

Telling Depression & Dementia Apart

In contrast to the gradual onset of dementia, pseudodemented depression
comes on rapidly. Furthermore, whereas the pseudodemented patient
appears distressed and may express fear of losing his mind, the person
with true dementia often seems relatively unconcerned and tends to
minimize his problem.

The truly demented patient is usually inattentive and has greater
impairment of recent than remote memory. In contrast, the depressed
patient, though attentive, will complain of both kinds of memory loss
and then test better than what he describes. He is also more likely to
have had previous similar episodes.

While a demented person may cooperate and try to bluff his way through
the testing, the pseudodemented person is often uncooperative, insisting
that he cannot do it. This should not be confused with malingering but
seen more as a reflection of the feeling of inadequacy that goes along
with serious depression.

Treating Pseudodementia

When treated (as depression), in contrast to true dementia,
pseudodementia often responds positively. While the depression may be
treatable, treatment rarely achieves a full reversal of the cognitive
impairment that made the doctor suspect dementia.

Clinical Suspicion is Essential

In summary, psychiatric symptoms that bring on dementia-like deficits in
the elderly result from a host of conditions. Many of them are readily
treatable, if properly recognized. The term "pseudodementia" provides a
"starting" language that offers a useful step in getting to a more
accurate diagnosis and treatment. A high index of clinical suspicion is
essential.

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NASGA (National Association to STOP Guardian Abuse, Inc.) is a 501(c)(3) public-interest, civil rights organization formed by victims of unlawful and abusive guardianships and conservatorships. We seek legislative reform of existing law and upgrading of criminal penalties for court-appointed fiduciaries misusing protective proceedings for unjust enrichment and engaging in elder and family abuse.

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